<%@ page contentType="text/html;charset=UTF-8" %>
<%@ include file="/WEB-INF/views/include/taglib.jsp"%>
<div class="content-wrap">
        <div class="wrapper" style="bottom: 50px;">
            <ul class="nav nav-tabs">
                <li>
                    <a href="#"  onclick="loadDiv('mainCenterDiv','${ctx}/med/medicalVsPatient/index')">医保卡与his人员关联列表</a>
                </li>
                <li class="active">
                    <a href="#" onclick="loadDiv('mainCenterDiv','${ctx}/med/medicalVsPatient/form')">
                        <c:choose>
                            <c:when test="${medicalVsPatient.id==''|| medicalVsPatient.id==null}">
                                医保卡与his人员关联添加
                            </c:when>
                            <c:otherwise>医保卡与his人员关联修改</c:otherwise>
                        </c:choose>
                    </a>
                </li>
            </ul>
            <section class="panel panel-default">
                <div class="panel-body">
                    <div class="col-lg-12">
                        <form:form id="inputForm" data-parsley-validate="" modelAttribute="medicalVsPatient" onsubmit="return formSaveLoad('mainCenterDiv','inputForm','${ctx}/med/medicalVsPatient/save','${ctx}/med/medicalVsPatient/index');" method="post" class="form-horizontal">
                            <form:hidden path="id"/>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">主键：</label>
                                    <div class="col-sm-4">
                                        <form:input path="id" htmlEscape="false" class="form-control"  maxlength="64" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">社保卡卡号：</label>
                                    <div class="col-sm-4">
                                        <form:input path="cardNo" htmlEscape="false" class="form-control"  maxlength="64" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">原来的医保手册号，医保身份的唯一标识：</label>
                                    <div class="col-sm-4">
                                        <form:input path="icNo" htmlEscape="false" class="form-control"  maxlength="64" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">省份证号码：</label>
                                    <div class="col-sm-4">
                                        <form:input path="idNo" htmlEscape="false" class="form-control"  maxlength="64" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">姓名：</label>
                                    <div class="col-sm-4">
                                        <form:input path="personname" htmlEscape="false" class="form-control"  maxlength="50" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">性别：</label>
                                    <div class="col-sm-4">
                                        <form:input path="sex" htmlEscape="false" class="form-control"  maxlength="2" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">生日：</label>
                                    <div class="col-sm-4">
                                        <form:input path="birthday" htmlEscape="false" class="form-control"  maxlength="18" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">转诊医院编码：</label>
                                    <div class="col-sm-4">
                                        <form:input path="fromhosp" htmlEscape="false" class="form-control"  maxlength="20" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">转诊时限：</label>
                                    <div class="col-sm-4">
                                        <form:input path="fromhospdate" htmlEscape="false" class="form-control"  maxlength="20" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">参保人员类别：</label>
                                    <div class="col-sm-4">
                                        <form:input path="persontype" htmlEscape="false" class="form-control"  maxlength="20" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">是否在红名单：</label>
                                    <div class="col-sm-4">
                                        <form:input path="isinredlist" htmlEscape="false" class="form-control"  maxlength="10" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">首本人定点医院：</label>
                                    <div class="col-sm-4">
                                        <form:input path="isspecifiedhosp" htmlEscape="false" class="form-control"  maxlength="2" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">是否本人慢病定点医院：</label>
                                    <div class="col-sm-4">
                                        <form:input path="ischronichosp" htmlEscape="false" class="form-control"  maxlength="12" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">个人账户余额：</label>
                                    <div class="col-sm-4">
                                        <form:input path="personcount" htmlEscape="false" class="form-control"  />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">慢病编码：</label>
                                    <div class="col-sm-4">
                                        <form:input path="chroniccode" htmlEscape="false" class="form-control"  maxlength="20" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">险种类型：</label>
                                    <div class="col-sm-4">
                                        <form:input path="fundtype" htmlEscape="false" class="form-control"  maxlength="10" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">预提人员标识：</label>
                                    <div class="col-sm-4">
                                        <form:input path="isyt" htmlEscape="false" class="form-control"  maxlength="2" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">军残等级：</label>
                                    <div class="col-sm-4">
                                        <form:input path="jclevel" htmlEscape="false" class="form-control"  maxlength="2" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">在院标识：</label>
                                    <div class="col-sm-4">
                                        <form:input path="hospflag" htmlEscape="false" class="form-control"  maxlength="2" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">病人Id：</label>
                                    <div class="col-sm-4">
                                        <form:input path="patientId" htmlEscape="false" class="form-control"  maxlength="64" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">标志：</label>
                                    <div class="col-sm-4">
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">创建人：</label>
                                    <div class="col-sm-4">
                                        <form:input path="createBy.id" htmlEscape="false" class="form-control"  maxlength="64" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">创建时间：</label>
                                    <div class="col-sm-4">
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">更新人：</label>
                                    <div class="col-sm-4">
                                        <form:input path="updateBy.id" htmlEscape="false" class="form-control"  maxlength="64" />
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">更新时间：</label>
                                    <div class="col-sm-4">
                                    </div>
                                </div>
                                <div class="form-group">
                                    <label class="col-sm-2 control-label">备注信息：</label>
                                    <div class="col-sm-4">
                                    </div>
                                </div>
                                <div class="form-group">
                                    <div class="col-sm-offset-2 col-sm-10">
                                        <input id="btnSubmit" class="btn btn-primary" type="submit" value="保 存">&nbsp;
                                        <input id="btnCancel" class="btn" type="button" value="返 回" onclick="loadDiv('mainCenterDiv','${ctx}/med/medicalVsPatient/index')">
                                </div>
                            </div>
                        </form:form>
                    </div>

                </div>
            </section>
        </div>
    </div>